Zinc sulfate supplementation for treatment of recurring oral ulcers

Regulation of NLRP3 inflammasome by zinc supplementation in Behçet's disease patients: A double-blind, randomized placebo-controlled clinical trial

BACKGROUND

Overproduction of NLRP3 inflammasome complex is one of the causes of Behcet's disease's (BD) auto-inflammatory nature. The aim of current study was to examine the effect of zinc supplementation on NLRP3 inflammasome expression; as well as clinical manifestations of BD.

METHODS

In this double-blind parallel placebo-controlled randomized clinical trial, 50 BD patients were randomly allocated into either zinc gluconate (30 mg/day elemental zinc) or placebo groups for 12 weeks. The mRNA expression of NLRP3 and caspase-1 in the leukocytes, serum level of zinc and IL-1β, anthropometric measures, and clinical manifestations of patients were collected at pre- and post-intervention phase. The Iranian Behçet's disease dynamic activity measure (IBDDAM) was scored to measure the treatment effect using the calculation of number needed to treat (NNT). Analysis of covariance was performed to obtain the corresponding effect sizes.

RESULTS

Zinc gluconate led to a significant improvement in genital ulcer (P = 0.019). Zinc supplementation decreased NLRP3 and caspase-1 genes expression compared with placebo group (baseline-adjusted P-value = 0.046 for NLRP3 and P-value = 0.003 for caspase-1), even after adjustment for the effect of confounding factors (baseline- and confounders-adjusted P-value = 0.032 for NLRP3 and P-value = 0.004 for caspase-1). Baseline and confounders adjusted effect size demonstrated that zinc was effective in reducing the serum level of IL-1β (P = 0.046). The NNT [95 %CI] for the rate of IBDDAM improvement was 3 [1.7-8.5].

CONCLUSIONS

Zinc gluconate supplementation (30 mg/day) for a 3-month period can be considered as an adjuvant therapy in alleviating inflammation and genital ulcer among BD patients.

Evaluation of serum zinc levels in patients with recurrent aphthous stomatitis (RAS)

BACKGROUND

Recurrent aphthous stomatitis (RAS) is an ulcerative disease of the oral mucosa without a clearly defined etiology. The aim of the study was to evaluate the serum zinc levels in patients with RAS in comparison to healthy controls and to validate the association between zinc levels and the course of RAS.

METHODS

Seventy-five patients with RAS and 72 controls underwent full dental examination. Serum zinc levels were determined by flame atomic absorption spectroscopy (F AAS). The results were statistically analyzed with Kruskal-Wallis, Mann-Whitney, chi-square tests and the test of difference between the two rates of structure with p < 0.05 as a significance level (Statistica 10, StatSoft®).

RESULTS

No statistically significant differences were detected in serum zinc levels between RAS patients and healthy controls. The mean serum zinc concentration was found to be 84.2 μg/dL in RAS group and 83.9 μd/dL in controls, within the accepted norms. Zinc deficiency was observed in 10.7% patients from the RAS group and in 6.9% controls. No significant differences in serum zinc levels were found between patients when the course of the disease was considered.

CONCLUSIONS

Serum zinc concentrations did not differ significantly in RAS patients and in healthy controls and it did not influence the course of the disease. Therefore, zinc does not appear to be an important modifying factor in the development of RAS.

A comparison of the effect of triamcinolone ointment and mouthwash with or without zinc on the healing process of aphthous stomatitis lesions

Background. Recurrent aphthous stomatitis (RAS) is one of the most common ulcerative diseases of the oral mucosa. Definitive etiology of RAS has not been conclusively established. There is no certain treatment for aphthous stomatitis but some drugs such as steroids are commonly used for the treatment of RAS. Regarding the effect of zinc on the healing process of epithelial layer and cell division, in this research the effect of triamcinolone (with orabase) in combination with a zinc-containing mouthwash and triamcinolone alone on the healing process of RAS lesions was assessed.

Methods. The present study consisted of 20 patients diagnosed with RAS. The patients were instructed to rinse the mouth-wash or placebo three times a day and triamcinolone ointment twice a day for two weeks. The largest dimension of the ulcer was measured by a digital caliper and the severity of pain was assessed by visual analogue scale (VAS). Number, size, duration, ulcer-free period and pain of the lesions were evaluated twice a week for twomonths. Data were analyzed by SPSS 16 using Mann-Whitney U test and t-test.

Results. A decrease was seen in the mean pain severity score (P = 0.631) and the size of the lesions but it was not statistically significant (P = 0.739). Also the difference between the number of lesions (P = 0.739), duration and ulcer-free period (P = 0.873) were not statistically significant.

Conclusion. Zinc mouthwash seems to be as effective on wound healing process as typical treatment modalities for RAS.

Zinc deficiency in patients with recurrent aphthous stomatitis: a pilot study

OBJECTIVE

Recurrent aphthous stomatitis is a common disease of the oral mucosa, affecting 20 per cent of the general population.1 However, the aetiology of this disease is unknown. This is the first controlled study to compare zinc levels in recurrent aphthous stomatitis patients with those of a well-matched, healthy, control population.

METHODS

Twenty-five patients with a history of recurrent aphthous stomatitis and 25 healthy people (control group) took part in the study. Patients aged between 20 and 40 years with recurrent oral aphthous ulcers less than 1 cm in diameter were included. Exclusion criteria were pregnancy and lactation, systemic disease (ulcerative colitis, Crohn's disease, Behçet's disease), any current medication (topical or systemic), dental surgery during the previous month and deficiencies in iron, folic acid or vitamin B1, B2, B6 or B12. Serum zinc levels were compared between patient and control groups.

RESULTS

Zinc deficiency was detected in 28 per cent of recurrent aphthous stomatitis patients and in 4 per cent of controls. The mean serum zinc level in the patient group was significantly lower than in the control group.

CONCLUSION

These results suggest an association between zinc deficiency and recurrent aphthous stomatitis.

Comparative analysis of salivary zinc level in recurrent herpes labialis

BACKGROUND

Recurrent Herpes Labialis (RHL) is one of most common infective vesiculoulcerative lesions. According to some studies administration of topical and/or systemic zinc compositions has been effective in treatment and prevention. This article aims to comparison of zinc level in healthy subjects and RHL patients in acute and convalescent phases.

MATERIALS AND METHODS

This was a retrospective case - control study, carried on 80 individuals (40 normal and 40 RHL patients) mean age=34.5 and 34.4, respectively. Saliva samples were taken in patients in acute phase once and after healing of lesions in convalescent phase (averagely 21 days later) and in normal individuals. Salivary zinc level concentration was measured by flame atomic absorption spectrophotometer by dry digestion method. The results were statistically analyzed with SPSS software by t-test (α=0.05).

RESULTS

Results showed that salivary zinc level in case group in acute and convalescent phases were 160.8 (ngr)/(ml)and 205.7 (ngr)/(ml) respectivly and significant differences between them were existed (P <0.05). Also significant differences were existed between zinc concentration in healthy subjects and patient groups (in both phases) (P=.001 and .002 for acute and convalescent phases respectively).

CONCLUSION

According to the results, zinc level is significantly lower in acute phase than in convalescent phase and significantly lower in both phases compared to healthy individuals,so determination of serum zinc level and prescribing zinc complement in low serum status has both treatmental and preventive effects in RHL patients.

Zinc supplementation for the treatment or prevention of disease: current status and future perspectives

Zinc is a nutritionally essential trace element, and thus zinc deficiency may severely affect human health. Many studies were published in which the effect of nutritional zinc supplementation on the incidence or severity of a certain disease was investigated. This review summarizes the main observations and aims to evaluate the use of nutritional zinc supplementation for prevention and treatment of human disease.

Recurrent aphthous ulcers today: a review of the growing knowledge

Recurrent aphthous ulcers represent a very common but poorly understood mucosal disorder. They occur in men and women of all ages, races and geographic regions. It is estimated that at least 1 in 5 individuals has at least once been afflicted with aphthous ulcers. The condition is classified as minor, major, and herpetiform on the basis of ulcer size and number. Attacks may be precipitated by local trauma, stress, food intake, drugs, hormonal changes and vitamin and trace element deficiencies. Local and systemic conditions, and genetic, immunological and microbial factors all may play a role in the pathogenesis of recurrent aphthous ulceration (RAU). However, to date, no principal cause has been discovered. Since the aetiology is unknown, diagnosis is entirely based on history and clinical criteria and no laboratory procedures exist to confirm the diagnosis. Although RAU may be a marker of an underlying systemic illness such as coeliac disease, or may present as one of the features of Behcet's disease, in most cases no additional body systems are affected, and patients remain otherwise fit and well. Different aetiologies and mechanisms might be operative in the aetiopathogenesis of aphthous ulceration, but pain, recurrence, self-limitation of the condition, and destruction of the epithelium seem to be the ultimate outcomes. There is no curative therapy to prevent the recurrence of ulcers, and all available treatment modalities can only reduce the frequency or severity of the lesions.

Recurrent aphthous ulceration in children--a review

The clinical presentation or recurrent aphthous ulceration in children is described together with current views on the aetiology and pathogenesis of the disease. Factors that predispose to this type of oral ulceration are discussed and a rational approach to the management of recurrent aphthous ulceration in children is proposed.

Recurrent aphthous ulceration with zinc deficiency and cellular immune deficiency

Zinc deficiency (serum zinc level 65 micrograms/dl) and cellular immune deficiency (confirmed by lymphoblastic transformation assay) were found in a 15-year-old boy who had had recurrent aphthous ulceration for 6 years. Despite the previous therapy (orally administered steroid, isoprinosine, interferon, lysozyme, and local treatment), the ulcers recurred monthly. After 3 months of zinc therapy (50 mg zinc sulfate orally three times daily) the aphthae disappeared and did not reappear for 1 year. The lymphoblastic transformation activity and serum zinc levels were also normalized with this treatment.

Zinc concentration in normal and healing gingival tissues in beagle dogs

Previous studies have shown that the administration of zinc (Zn) may enhance the healing of gingival and other wounds. This study was undertaken to determine if Zn concentration ([Zn]) is increased in healing gingival tissues and if oral supplementation of Zn would result in a local increase in [Zn] within these tissues. On Day 0, biopsies were obtained from the maxillary left buccal gingiva of each of 10 beagle dogs. Gingival biopsies were taken from the healing original biopsy sites on Day 14. On Day 15, oral supplementation of Zn gluconate (250 mg/day, equivalent to 32.5 mg of elemental Zn) was begun in seven dogs. Three dogs remained as unsupplemented controls. Two weeks later (Day 28), normal gingival biopsies were obtained from the right side of the maxilla and on Day 42 final biopsies were taken from the same healing sites. In addition, serum samples were obtained on Days 0, 14, 28 and 42. All samples were analyzed for Zn content using atomic absorption spectrophotometry. The [Zn] of healing tissues was significantly higher (P less than 0.0005) than normal tissues. This was also true when healing tissues were compared to normal tissues during the Zn supplementation phase (Day 28 vs. Day 42; P less than 0.005). Zn supplementation resulted in significant increases in Zn levels in normal (Day 0 vs. Day 28; P less than 0.05) and healing tissues (Day 14 vs. Day 42; P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

A double-blind trial of systemic zinc sulfate in recurrent aphthous stomatitis

A double-blind crossover study of the effects of systemic zinc sulfate was carried out on twenty-five patients with recurrent aphthous stomatitis. No therapeutic effect was seen with the use of systemic zinc over a 3-month period. This study fails to confirm the beneficial effects of zinc seen in previously reported studies. Four patients had to discontinue the zinc therapy because of side effects. The empirical use of systemic zinc sulfate supplementation in the treatment of recurrent aphthous stomatitis is not recommended.

Betamethasone-17-benzoate in the treatment of recurrent aphthous ulcers

A double-blind study of the effectiveness of betamethasone-17-benzoate in the treatment of recurrent aphothous ulcers (RAU) was concucted. The drug was found to be effective in reducing symptoms and shortening healing time but not in preventing recurrences. Evaluation of the medical histories and laboratory studies suggests that multiple factors may be involved in the etiology of RAU, as reported by others.